| NPI | 1265558456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 10186) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL000114L) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2015-03-18 |